Risky Glaucoma Treatment

Older patients who are treated with topical beta blockers for glaucoma, a major cause of blindness, may be at a higher risk of airways obstruction—even if they have no history of respiratory disease, say researchers from the Institute of Ophthalmology, Royal Brompton Hospital, and Moorfields Eye Hospital, all in London. Analyzing data from 11,739 patients, they found enough of a heightened risk to recommend that frail elderly patients not be given beta-blocker therapy for glaucoma.

Although topical beta blockers are the most widely prescribed drugs for glaucoma in the United Kingdom, they have been known to exacerbate broncho-spasm in patients with asthma and chronic obstructive pulmonary disease and they affect respiratory function in elderly patients with no previous history of airways obstruction. In this study, the attributed risk of new development of respiratory disease was 1,000 patients per year in the United Kingdom, or one case every 11 years for a general practitioner.
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Patients with pre-existing airways obstruction might be even more sensitive to beta blockers, the researchers suggest. If airways obstruction develops, they advise discontinuing the drug immediately and notifying the patient’s ophthalmologist. A refilled prescription that includes topical beta blockers and drugs for asthma should automatically signal an alarm, they warn. The study authors even suggested that many frail elderly patients for whom loss of eyesight was not an immediate threat might fare better with no treatment rather than face a risk of airways obstruction.